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Chronic Sialadenitis: Etiology, Pathogens, Clinic, Diagnostics

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Chronic Sialadenitis: Etiology, Pathogens, Clinic, Diagnostics MINISTRY OF HEALTH OF UKRAINE Ukrainian medical stomatological academy “Approved” On the meeting chair Of Propaedeutics Surgical Stomatology The Head of the Department prof. Novikov V.M. ___________ “ ____ ” _____________ 20 ____ GUIDELINES Individual work of students During preparation for Practical classes Educational discipline Surgical stomatology Module № 2 Inflammatory diseases in maxillofacial region. Nonodontogenous inflammatory diseases in Content module № 4 maxillofacial region Chronic sialadenitis: etiology, pathogens, clinic, Theme lesson diagnostics, medical treatment. Course 3 Faculty Stomatological Poltava 2018 1. Actuality of the topic: The inflammatory diseases of salivary glands pretty often meet in practice of surgeon-stomatology. The knowledge of etyopathogenesis this group of diseases is a necessity for timely diagnostics, correct planning and choice of methods treatment and prophylaxis of complications. 2. The objectives of the studies: To know: anatomotopographical features of large salivary glands and their exretory ducts; etiology and pathogeny of acute viral and bacterial inflammatory diseases of salivary glands, their characteristic clinical symptoms. To be able: to collect anamnesis of disease; to recognize the symptoms of diseases; to set a diagnosis and to appoint necessary treatment. To seize: by the methods of diagnostics; by the technique of massage of major salivary glands; by the technique of introduction of medicinal matters in the exretory duct of parotid salivary gland. 3. Basic knowledge, skills, skills necessary for study topics (interdisciplinary integration). Name of previous These skills courses Anatomy Schematically to represent the location of major salivary glands and opening their exretory ducts. Physiology To interpret information of laboratory methods of functional inspection of major salivary glands. Clinical pharmacology To be able to write the recipes of medications for this category of patients. 4. Tasks for independent work in preparation for the classes. 4.1. A list of key terms, parameters, characteristics that must learn the student in preparation for the lesson: Term Definition Sialography sialogram, or radiosialography is the radiographic examination of the salivary glands Sialectasis abnormal dilation of the ducts of a salivary gland 4.2. Theoretical questions to lesson: 1. To name the large salivary glands. 2. Classification of chronic sialadenitiss. 3. Etiology and pathogeny of chronic sialadenitiss. 4. Diagnostic signs of chronic interstitial sialadenitis. 5. Diagnostic signs of chronic parenchymatous sialadenitis. 6. Diagnostic signs of sialodochitis. 7. Methods of investigation of children with the diseases of salivary glands. 8. Principles and methods of treatment of different forms of chronic sialadenitis at children. 4.3. Practical works (tasks) are performed in class: 1) To conduct the examination of patient with the chronic diseases of salivary glands; 2) To conduct the differential diagnostics of chronic sialadentis with other diseases; 3) To work out a plan of treatment of patient with sialadenitis. 5. The text contents of theme. Inflammatory processes involving the salivary glands are caused by a multitude of etiological factors. The process may be acute and may result in an abscess formation particularly as a result of bacterial infection. The involvement can be unilateral or bilateral as in viral infections. Chronic sialadenitis may be nonspecific resulting from ductal obstruction due to sialolithiasis or external radiation or may be specific, caused by various infectious agents and immunologic disorders. Histologically with chronic sialadenitis, there are varying degrees of acinar atrophy, lymphoid infiltrate with or without germinal centers, and fibrosis. The ducts exhibit dilatation and hyperplasia of the lining epithelium with various metaplasias. Extensive dilatation will result in cyst formation. Goblet cell metaplasia produces abundant mucin. The lobular architecture is usually maintained. An extreme example of obstructive changes with marked acinar atrophy is encountered in submandibular glands and is known as chronic sclerosing sialadenitis or Küttner's tumor. Recurrent parotitis is defined as recurrent inflammation, generally associated with non-obstructive sialectasis of the parotid gland. Also known as juvenile recurrent parotitis, this disease is characterised by recurring episodes of swelling and/or pain in the parotid gland, usually accompanied by fever and malaise. It is a rare condition, and its etiology remains an enigma. Its natural history is variable, and in adults more aggressive intervention is often needed. In addition, there is no satisfactory explanation for its usual tendency to resolve spontaneously after puberty. All this has resulted in considerable uncertainty concerning its appropriate management. Aetiology. Its cause remains unknown despite several studies. Though the affected glands demonstrate sialectasis of the distal ducts, there seems to be no element of obstruction in most cases. Several theories of causation have been put forward over the years.Traditionally, ascending infection from the oral cavity has been considered the primary event, with sialectasis being a secondary change. There is first a low grade inflammation of the gland and duct epithelium, possibly caused by a low salivary flow rate due to dehydration and debility.This results in distortion and stricturing of the distal ducts, and metaplasia of the duct epithelium. The metaplasia results in excessive mucus secretion. These changes, along with possibly a further reduction in salivary flow rate, then predispose to recurrent parotid inflammations. A reduced salivary flow rate may result from glandular damage caused by the primary infection. However, it may be a primary factor as well. Several workers showed low salivary flow rates, and the significant finding was that the flow rate was reduced in even the unaffected glands in patients with unilateral disease. This suggests that those with low salivary flow rates might be predisposed to suffer from repeated ascending infections. This relation to salivary flow rates could also explain the familial tendency that has been reported. The histological picture includes lymphocytic infiltration around the intralobular ducts, and Patey and Thakray proposed that this lymphocytic infiltration damages the duct wall reticulum, allowing extravasation of secretions into the gland parenchyma, and thus exacerbating the inflammation. The fragmentation of connective tissue sup- porting the intralobular ducts was also implicated by these authors in the production of the characteristic punctate sialectasis. They proposed that the dye used for sialography ruptured the already weakened duct walls, producing the appearance of punctate sialectasis. This theory therefore neatly explained the presence of sialectasis in the absence of demonstrable distal obstruction. The situation, however, is not as simple. Punctate sialectasis is seen in totally asymptomatic glands of affected individuals in up to 70% of cases. Further, detailed histopatho- logical studies have confirmed the presence of duct dilatation and cystic cavities associated with a chronic inflammatory process. And more recently, ultrasonography consistently revealed hypoechoic areas that corresponded to the punctate sialectases demonstrated by syalography. As long ago as 1945, Hamilton Bailey proposed the presence of a congenital abnormality of the ductal system, and drew a parallel with bronchiectasis. He pointed out that bronchiectasis could be congenital as well as acquired, and in both cases, the end result was secondary infection of the bronchioles and alveoli. He has been subsequently supported by several others. According to this argument, punctate dilatation of the small distal ducts results in stasis and ascending infection, giving rise to the recurrent acute attacks. Though no evidence has so far emerged in favour of a congenital abnormality, it is still possible that genetic factors may prove important. Given this state of incomplete knowledge, the present consensus is towards a multifactorial approach. Thus Kono and Ito concluded that the sialectasis is both the cause and the result of recurrent parotitis. Their histological studies detected dilated cavities consistent with true sialectasis, as well as a few areas of extravasated dye which mimicked sialectasis on the sialogram. Similarly, a detailed study of clinical, radiological, immunological, bacteriological, and histological findings in 20 affected children concluded that the cause was probably a combination of a congenital malformation of portions of the salivary ducts and infections ascending from the mouth after dehydration of the affected children. However, it must also be acknowledged that juvenile recurrent parotitis can occasionally occur without sialectasis. One child has suffered repeated attacks of parotitis secondary to repeated chewing of the Stenson’s duct orifice. Many associations have been proposed in the past; these include immunodeficiency, allergy, upper respiratory infections, mumps, etc. None of these, however, has been conclusively shown to have any bearing on this disease. Friis et al and others proposed an autoimmune origin, but the self limiting nature of recurrent parotitis and the absence of detectable autoantibodies makes this unlikely. There have been reports of sensitivity to upper respiratory tract infections; these infections may set off attacks of sialadenitis merely
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